Significant cost reduction with cascading test approaches

A simplified solution

Celiac disease is a chronic inflammatory condition that primarily affects the small intestine. It is caused by an inflammatory response mounted by the patient’s own immune system against dietary gluten, which ultimately results in damage and atrophy of the villae within the small intestine.

While the diagnostic criteria of celiac disease are well defined, symptoms are generally nonspecific. This fact, combined with the variety of available tests — each with a specific utility and interpretation — can make a diagnosis quite challenging.

An algorithmic testing approach

Working closely with our clinical GI colleagues, we have established several cascading algorithms to aid in the diagnosis of celiac disease. These algorithms, each with a specific utility, use automatic reflexing to perform the necessary tests and are available as orderable clinical tests.

Knowledge about the patient’s clinical presentation, past treatment, and previous laboratory testing is critical to selecting the most appropriate algorithm.

The challenge of celiac disease diagnosis

Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. According to the Celiac Disease Foundation, it is estimated to affect 1 in 100 people worldwide. Approximately 2.5 million Americans are undiagnosed and are at risk for long-term health complications. Establishing an accurate diagnosis is critical for improved quality of life and prevention of associated side effects. Unfortunately, celiac disease is a challenge to diagnose.

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Key testing

CDSP | Celiac Disease Serology Cascade, Serum

Benefits of this cascade:

  • Available when HLA DQ typing is not desired or has been performed previously
  • Interpretive report includes recommendations on the need for confirmatory biopsy

CDCOM | Celiac Disease Comprehensive Cascade, Serum and Whole Blood

Benefits of this cascade:

  • Includes both serologic and genetic testing (HLA DQ typing)
  • Can completely rule out CD in about 50% of patients based on HLA typing
  • Includes individual test results, clinical interpretation, and recommendations on whether to proceed to biopsy or pursue another diagnosis

CDGF | Celiac Disease Gluten-Free Cascade, Serum and Whole Blood

Benefits of this cascade:

  • Developed to assist in evaluating patients who have already reduced gluten in their diets
  • Includes HLA DQ typing as the initial test

CELI | Celiac Associated HLA-DQ Alpha 1 and DQ Beta 1 DNA Typing, Blood

Benefits of this test:

  • Assists in guiding therapy decisions by determining immunogenicity to anti-TNF therapy through genetic typing of the HLA-marker DQA1*05 allele.
  • To learn more about celiac disease testing at Mayo Clinic Laboratories, click here.

Significantly reducing costs: A case study

Learn more about how to order these evaluations at your institution.